Under Pressure

To understand carpal tunnel syndrome, it helps to have a visual metaphor. Picture a train going into a narrow tunnel. Now imagine the walls of that tunnel closing in, squeezing the train until it can no longer stay on track and the engineer can’t read the signals up ahead. Not vivid enough? OK, then picture yourself on the Pirates of the Caribbean ride at Disney World — the part where the cavern gets more narrow and you can hear the pirates around the next bend about to go all swashbuckling on you, and your hands get all numb and tingly? Still not clear? Maybe we should let the doctors explain it.
Carpal tunnel syndrome is a neurological issue — the most common nerve entrapment syndrome out there, according to Dr. Robert Larkin, who practices internal medicine at Catholic Medical Center. The median nerve travels through the narrow pathway formed by the carpal ligament and the bones at your wrist. But when swelling or other factors put pressure on the nerve, it can’t function as well as it should. Women are three times more likely to have the syndrome than men. Chock a lot up to biology: some people are more prone to it because their carpal tunnel is simply smaller than others.
“It’s a tight fit to begin with when things are working properly,” says Larkin. “When you have swelling that places pressure on the median nerve or it gets irritated, you get that sort of numb and tingling feeling.”
Swelling can come from a variety of places, from an injury like breaking your wrist to the stress from using a vibrating jackhammer or working on an assembly line all day. It can also arise from hormonal causes such as hypothyroidism or retaining fluids during pregnancy.
Given that the average person spends about six hours a day on the computer, you’d think that there might be a rise in incidents of carpal tunnel syndrome in today’s push-button society. Although symptoms can sometimes be exacerbated by doing repetitive motions like banging away at the keyboard, most doctors will point to a lack of research that prove that’s the real cause for carpal tunnel syndrome.
Larkin says he’s seen only a smattering of patients with carpal tunnel syndrome in his seven years of practicing, but estimates put those affected by the disease at about 2-3 percent of the population. (As Larkin points out, in a country of 300 million, that’s 6 million sufferers, making this no small-potatoes disease. Not to mention that one statistic puts the average lifetime cost of this syndrome at about $30,000 per person affected, taking into account medical bills and time off from work.)
It’s all about the twist of your wrist. Tapping the keys for hours at a time or clenching a video game controller doesn’t necessarily condemn you to a life of carpal tunnel pain — but it could put you at risk for other repetitive motion disorders like bursitis and tendonitis.
Lauren Smit first noticed the symptoms of her carpal tunnel syndrome about four years ago, when she started waking up with numb hands. “It’s not like a pins-and-needles numb, it’s more like an ‘If you cut off my finger I won’t feel it’ kind of numb,” she says. (One of the hallmark signs of carpal tunnel is numbness or tingling in the thumb, index and middle finger, the three fingers affected by the median nerve.)
Although her symptoms weren’t typical — as a knitter and someone who works on the computer for a large part of the day she doesn’t experience these sensations during the daytime — she suspected something was amiss when she would wake up lying on her right side and yet her left hand would be numb. “Most people expect it to be while working on the computer, or a carpenter hammering nails; no one expects it while you’re sleeping,” says Smit.
Turns out Smit tends to sleep with her hands all curled up, and that pinches the nerves in her wrist. Driving long distances at the steering wheel and even something as simple as dangling her wrist off of the armrest of an airplane during a flight also affects her.
Smit has an interesting perspective: she is a doctor of osteopathic medicine (D.O.) in a family practice, so she has seen this problem from a clinical as well as a personal side. She says there is no way to gauge other people’s pain because everybody is affected differently. For some really bad cases, it can be debilitating, and the muscles start to waste in the patient’s hand. Luckily for Smit, “It’s a disturbing sensation, and I can see it getting to painful. For now, it’s just bothersome.”
For Smit, wearing braces, or wrist splints, for the past four years has brought the problem under control. She admits it’s not the most romantic look, and the awkward feeling of having her wrists kept straight took some getting used to, but the alternative is much worse.
Braces are a good starting point for treatment options if your symptoms are mild or caught early on, advises Daniel Kunz, a D.O. at Exeter Hospital, as are stretches and good posture. Take people whose condition worsens when clenching the steering wheel: “Driving with your wrists in a neutral position, with good alignment of your neck and upper body, can help,” says Kunz. Other treatments include corticosteroid injections or over-the-counter anti-inflammatory drugs. “Some people have even tried yoga and ultrasound technology — using electrical stimulation to promote soft tissue healing by using sound waves to break up inflammation and scar tissue in order to try to relieve the pressure,” says Kunz.
In extreme cases, surgery might be considered. “Surgery is very effective, but a last effort. Typically you’d do surgery only as a last option,” says Kunz. NH

This article appears in the August 2007 issue of New Hampshire Magazine